Nursing the Nurse: Forceps Delivery

Forceps Delivery

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Forceps Delivery

Description:

Forceps are instruments designed to aid in the delivery of the fetus by applying traction to the fetal head. Many different types of forceps have been described and developed. Generally, forceps consist of 2 mirror image metal instruments that are maneuvered to cradle the fetal head and are articulated, after which traction is applied to effect delivery.

Materials/Equipments needed:

· Oxygen with flow meter (one setup for mother and another for infant)

· Delivery bed

· Setup for infant (infant warmer, oxygen with bag and mask, suction with DeLee aspirator, infant laryngoscope, intubation equipment, umbilical catheter, medications, and monitoring equipment for resuscitation)

· Sterile equipment tray or table containing the following:

o 10-mL tube for cord blood

o Two scissors (blunt Mayo-Noble straight scissors for cutting the cord and/or episiotomy and sharp scissors for cutting suture and dressings)

o Bulb syringe

o One plastic cord clamp (may use curved forceps for the other)

o Four curved hemostats

o Two straight forceps

o Two ring forceps clamps (also called a sponge stick or placenta forceps)

o Drapes and towels (including under buttocks drape with fluid pouch)

o Placenta basin

o Gown (optional) and sterile gloves (latex free recommended)

o
Tucker-McLean or Simpson forceps

Procedure:

The cervix must be fully dilated.
The bladder should be empty - a catheter may be used to achieve this.
The mother is placed in the lithotomy position (on her back with her legs supported in stirrups).
Some form of local anaesthetic is administered, if an epidural is not already in place.
The forceps blades are inserted one at a time and locked into position around the baby's head.
If necessary the doctor rotates the head into a favourable position.
The head is then pulled right down onto the perineum.
An episiotomy is performed.
The baby's head is lifted out and then the body.
The baby is treated and observed as necessary.
The placenta is delivered, following an injection of Syntocinon or ergometrine.
The episiotomy wound is sutured.

Effects on the mother
Advantages:

	1.	When the mother is exhausted or unable to push it allows the baby to be born without her physical effort.
	2.	When pushing is contra-indicated, for example with severe pre-eclampsia, the baby can be born.

Disadvantages:

	1.	Because the birth is assisted, the mother misses the experience of pushing the baby out herself.
	2.	The local or epidural anaesthetic numbs the perineal area so that the mother doesn't feel the baby emerging.
	3.	An episiotomy is usually routine.
	4.	The need for analgesia, often a pudendal block, or an epidural.
	5.	Bruising of internal tissues, and additional strain on pelvic floor muscles.

Effects on the baby
Advantages:

	1.	Where fetal distress is present, a forceps delivery may be life-saving, or prevent the baby from becoming very hypoxic (oxygen-starved) which, if severe, can lead to brain damage or death.
	2.	May be necessary to protect the baby's head, for example a premature birth or breech presentation.
	3.	May be the only way that birth can be achieved, if the baby is malpositioned.

Diagram/Illustration:

Postoperative details:

After forceps delivery, a detailed examination of the maternal pelvis and a rectal examination are essential to help diagnose and treat hidden lacerations. The newborn also should be carefully examined.

A high index of suspicion is necessary to help diagnose and treat the complications of operative vaginal deliveries. Severe and painful edema of the vulvovaginal area is common in these patients. Along with other injuries, this can make spontaneous voiding difficult, in which case an indwelling catheter should be placed. Proper postoperative pain control is essential. These patients are at increased risk for hemorrhage, and a postoperative hemogram should be obtained and the condition corrected as needed.

Before discharge, pelvic and rectal examinations may help confirm the integrity of pelvic organs and may exclude such entities as pelvic hematoma, rectal tears, and misplaced sutures. Diagnostic studies should be ordered as needed.

Follow-up care:

In the absence of specific forceps-related complications, a follow-up postpartum examination within 4-6 weeks, with a thorough pelvic examination, usually is sufficient.

Disadvantages:

	1.	In the hands of an experienced doctor there should be little trauma to the baby. There may be some bruising or temporary markings on the baby's face.
	2.	The baby may suffer from the effects of the increased need for analgesia.
	3.	There is always some degree of force used in a forceps delivery and it is difficult to know what effect this force has on the baby's head and spine. If your baby has been born with the aid of forceps and is very irritable, it might be worthwhile having its neck checked for misalignment of the vertebrae in its spine.